Low profile non-symmetrical stent
A stent for use in a medical procedure having opposing sets of curved apices, where the curved section of one set of apices has a radius of curvature that is greater than the curved section of the other set of apices. One or more such stents may be attached to a graft material for use in endovascular treatment of, for example, aneurysm, thoracic dissection, or other body vessel condition.
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This application is a continuation of U.S. application Ser. No. 12/622,351, filed Nov. 19, 2009, which is a continuation of U.S. application Ser. No. 12/472,082, filed May 26, 2009, which is a continuation-in-part of Ser. No. 12/332,904, filed Dec. 11, 2008, which claims the benefit of U.S. Provisional Application Ser. No. 61/016,753, filed Dec. 26, 2007, and also claims priority under 35 U.S.C. §119 to Great Britain Patent Application No. GB0920235.9, filed Nov. 18, 2009 and to Great Britain Patent Application No. GB0920327.4, filed Nov. 19, 2009, which are incorporated in their entirety by reference herein.
FIELD OF THE INVENTIONThe present invention relates generally to stents for use in body vessels to treat medical conditions. In particular, this invention relates to an asymmetric stent having opposing sets of curved apices, where the curved section of one set of apices has a radius of curvature that is greater than the curved section of the other set of apices, and may present a lower profile, better compliance with irregular vascular geometry, and higher sealing forces than conventional stents.
BACKGROUNDStents may be inserted into an anatomical vessel or duct for various purposes. Stents may maintain or restore patency in a formerly blocked or constricted passageway, for example, following a balloon angioplasty procedure. Other stents may be used for different procedures, for example, stents placed in or about a graft have been used to hold the graft in an open configuration to treat an aneurysm. Additionally, stents coupled to one or both ends of a graft may extend proximally or distally away from the graft to engage a healthy portion of a vessel wall away from a diseased portion of an aneurysm to provide endovascular graft fixation.
Stents may be either self-expanding or balloon-expandable, or they can have characteristics of both types of stents. Various existing self-expanding and balloon-expandable stent designs and configurations comprise generally symmetrical end regions including one or more apices formed of nitinol or another alloy wire formed into a ring. The apices commonly comprise relatively acute bends or present somewhat pointed surfaces, which may facilitate compression of the stent to a relatively small delivery profile due to the tight bend of the apices. Although having this advantage, in some situations, such relatively acute or pointed apices may be undesirable, in particular in vessel anatomies that are curved or tortuous such as, for example, the thoracic aorta.
The thoracic aorta presents a challenging anatomy for stent grafts used to treat thoracic aneurysms or dissections. The thoracic aorta comprises a curve known as the aortic arch, which extends between the ascending thoracic aorta (closet to the heart) and the descending thoracic aorta (which extends toward the abdominal aorta). Thoracic stent grafts are used to exclude thoracic aortic aneurysms. A stent graft's ability to conform to the tortuous anatomy of the aortic arch is a major concern. Current designs sometimes lack the desired sealing ability at the proximal end of the stent graft (closest to the heart). Also, current thoracic devices present a relatively large profile which, with some patients' anatomies may be problematic. Finally, many current stents have relatively acute points that may prevent them from being used in the aortic arch for fear of undesirable interaction with the artery wall after an extended amount of time in the patient.
Therefore, a generally nonsymmetrical stent having at least one relatively rounded apex that is less invasive in an expanded state than stents with more acute apices may alleviate the above problems, while providing an improved compliance to the aortic arch and increased radial force if used as a sealing and/or alignment stent, as well as a desirable ability to be crimped to a readily introducible diameter.
As one particular example, type-A thoracic aortic dissection (TAD-A) is a condition in which the intimal layer of the ascending thoracic aorta develops a tear, allowing blood to flow into the layers of the aortic wall, causing the development of a medial or subintimal hematoma. TAD-A is associated with a strikingly high mortality rate (about one-fourth to one-half of victims die within the first 24-48 hours). The only current treatment for TAD-A is open surgery, where the chest is opened, the aorta is clamped, and a vascular prosthesis is sewn in place. Operative mortality rate for this procedure may be around 10%. Endovascular treatment of TAD-B (which affects the descending thoracic aorta) has been effective in reducing short-term and longer term mortality. Therefore, it is desirable to provide an endovascular device configured to address the anatomic challenges of the thoracic aorta.
SUMMARYThe present invention relates generally to stents for use in body vessels to treat medical conditions. In particular, this invention relates to a stent having opposing sets of curved apices, where the curved section of one set of apices has a radius of curvature that is greater than the curved section of the other set of apices, and may present a lower profile than conventional stents. This configuration present an asymmetrical stent. Specifically, embodiments of the presently-presented stent may maintain a low profile while improving compliance with highly tortuous anatomy (such as, for example, that found in the region of the thoracic aorta and particularly the aortic arch) while providing improved radial sealing force compared to some current devices. In another aspect, the presently-presented stent may provide support and spacing within the larger context of a stent or stent-graft device that will allow, for example, placement of ancillary stents and/or stent-grafts.
In one example, the present invention may include a stent that includes at least one proximal apex and at least one distal apex connected with the proximal apices by a plurality of generally straight portions; where each proximal apex includes a first curved portion and each distal apex comprises a second curved portion; where the first curved portion and the second curved portion each includes at least one radius of curvature, and the radius of curvature of at least one of the proximal apices is greater than the radius of curvature of at least one of the distal apices.
In another example, the present invention may include at least one wire formed into stent including a ring of alternating opposed, generally curved apices where a radius of curvature of a plurality of the apices in a first direction is greater than a radius of curvature of the apices in an opposite direction.
Advantageously, the rounded apices may provide atraumatic contact with a vessel, while the combination of more rounded and less rounded apices provides for a low-profile stent that includes desirable compressibility during introduction and desirable compliance and sealing profiles when deployed in a vessel.
The invention can be better understood with reference to the following drawings and description. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. Moreover, in the figures, like referenced numerals designate corresponding parts throughout the different views.
The present invention relates generally to stents for use in body vessels to treat medical conditions. In particular, this invention relates to a novel asymmetric stent having opposing sets of curved apices, where the curved section of one set of apices has a radius of curvature that is greater than the curved section of the other set of apices, and may present a lower profile than conventional stents. The lower profile may present advantages for use in patients with particularly tortuous or small-diameter vessels.
In the present application, the term “proximal” refers to a direction that is generally closest to the heart during a medical procedure, while the term “distal” refers to a direction that is furthest from the heart during a medical procedure. Reference throughout is made to proximal and distal apices, but those of skill in the art will appreciate that the proximal-distal orientation of stents of the present invention may be reversed without exceeding the scope of the present invention.
As shown in
The asymmetric stent may be configured such that, when used with a graft, it will provide a sufficiently strong radial force at the graft's end openings to hold the graft material open against the artery wall. Also, the stent is intended to be short in length so that the graft will include flexibility sufficient to accommodate a patient's anatomy. This combination of flexibility and strong radial force provides an improved seal between the graft and artery wall. In addition, enhanced flexibility is provided as well, particularly when one or more stents are used to provide short segments and better accommodate curves.
In these and other examples, the ratio of the proximal apices' radius of curvature to the distal apices' radius of curvature may be about 2.6:1 to about 18:1, and desirably may be about 6:1. The outer circumference of the stent 200 preferably is generally consistent such that, in this configuration, a solid outer face around the stent 200 would form a cylinder, although the stent will most preferably provide compliance with a surface less smooth than a cylinder.
The rounded points on the stent may protrude from the graft material only a small amount as is shown in
As shown in the end view of
Stent examples of the present invention may be constructed of NiTi alloys or other materials presently known or yet to be developed, all within the scope of the present invention. The stents preferably are made from Nitinol wire and will therefore be MRI compatible. In another preferable embodiment, a stent may be made from a laser-cut Nitinol cannula, effectively rendering it a seamless or nearly-seamless wire-like construction. Nitinol's superelastic properties will facilitate the stents ability to be crimped down into a low profile delivery system.
Although various examples of the invention have been described, the invention is not to be restricted except in light of the attached claims and their equivalents. Moreover, the advantages described herein are not necessarily the only advantages of the invention and it is not necessarily expected that every example of the invention will achieve all of the advantages described. Different embodiments not expressly described herein including those with features combined in a different manner than expressly illustrated herein may be practiced within the scope of the present invention. For at least these reasons, this narrative description should not be construed as defining the invention; rather, the claims set forth and define the present invention.
Claims
1. A stent graft comprising:
- a tube of graft material having a proximal end and a distal end;
- a plurality of stents attached to the tube of graft material between the proximal and distal ends;
- a first stent of the plurality of stents, the first stent comprising a plurality of proximal apices and a plurality of distal apices, where each proximal apex comprises a first curved portion and each distal apex defines a second curved portion, where in the first curved portion and the second curved portion each comprises a radius of curvature, and the radius of curvature of the proximal apices is greater than the radius of curvature of the distal apices;
- a second stent of the plurality of stents disposed immediately adjacent and distal of the first stent, the second stent comprising a plurality of distal apices and a plurality of proximal apices, where each distal apex comprises a first curved portion and each proximal apex defines a second curved portion, where in the first curved portion and the second curved portion each comprises a radius of curvature, and the radius of curvature of the distal apices is greater than the radius of curvature of the proximal apices;
- wherein each distal apex of the first stent substantially abuts a proximal apex of the second stent; and
- wherein the radius of curvature of the distal apices of the first stent and the radius of curvature of the proximal apices of the second stent is from about 0.5 mm to about 1.5 mm, and wherein the wherein the radius of curvature of the proximal apices of the first stent and the radius of curvature of the distal apices of the second stent is from about 4 mm to about 9 mm.
2. The stent graft of claim 1, wherein a ratio of the radius of curvature of the proximal apices of the first stent to the radius of curvature of the distal apices of the first stent is between about 2.6:1 to about 18:1.
3. The stent graft of claim 2, wherein a ratio of the radius of curvature of the distal apices of the second stent to the radius of curvature of the proximal apices of the second stent is between about 2.6:1 to about 18:1.
4. The stent graft of claim 1, wherein a ratio of the radius of curvature of the distal apices of the second stent to the radius of curvature of the proximal apices of the second stent is between about 2.6:1 to about 18:1.
5. The stent graft of claim 1, wherein each of the proximal and distal apices of the first stent and each of the proximal and distal apices of the second stent are connected by struts.
6. The stent graft of claim 5, further comprising at least one area of unstented graft material, wherein the at least one area of unstented graft material has a perimeter defined by the proximal apices and struts connecting the proximal apices of the first stent and the distal apices and struts connecting the distal apices of the second stent.
7. The stent graft of claim 6, wherein the at least one area of unstented graft material comprises an aperture within the area of unstented graft material, wherein the aperture is configured to receive a tubular graft therethrough.
8. The stent graft of claim 7, further comprising a second area of unstented graft material comprising an aperture in the second area, wherein the aperture of the second area of unstented graft material is configured to receive a second tubular graft therethrough.
9. The stent graft of claim 7, wherein the proximal apices of the first stent have a rounded inner radius.
10. The stent graft of claim 9, wherein the aperture is disposed within the rounded inner radius of a proximal apex of the first stent.
11. The stent graft of claim 1, wherein the proximal apices of the first stent have a rounded inner radius.
12. The stent graft of claim 11, further comprising an aperture disposed within the rounded inner radius of a proximal apex of a first stent, wherein the aperture is configured to receive a tubular graft therethrough.
13. The stent graft of claim 12, further comprising a second aperture disposed within the rounded inner radius of a second proximal apex of the first stent, wherein the second aperture is configured to receive a second tubular graft therethrough.
14. The stent graft of claim 1, wherein the distal end of the stent graft is bifurcated.
15. The stent graft of claim 1, wherein the plurality of stents includes at least one stent having proximal and distal apices having the same radius of curvature.
16. A stent graft comprising:
- a tube of graft material having a first end and a second end;
- a plurality of stents attached to the graft material between the first and second ends, first and second stents of the plurality of stents being disposed directly adjacent one another and entirely between the first and second ends of the tube of graft material;
- wherein the first stent has proximal apices and distal apices each having a curve, wherein the curve of the proximal apices of the first stent is greater than the curve of the distal apices of the first stent;
- wherein the second stent has proximal and distal apices each having a curve, where the curve of the distal apices of the second stent is greater than the curve of the proximal apices of the second stent;
- wherein the distal apices of the first stent substantially abut the proximal apices of the second stent;
- wherein each of the proximal apices of the first stent has a rounded inner radius and each of the distal apices of the second stent has a rounded inner radius directly opposite a rounded inner radius of a proximal apex of the first stent, and
- wherein an area of unstented graft material is disposed between the rounded inner radii of the proximal apices of the first stent and the rounded inner radii of the distal apices of the second stent, and
- wherein each of the proximal and distal apices of the first stent having a radius of curvature, and each of the proximal and distal apices of the second stent have a radius of curvature, wherein the radius of curvature of the distal apices of the first stent and the radius of curvature of the proximal apices of the second stent is from about 0.5 mm to about 1.5 mm, and wherein the wherein the radius of curvature of the proximal apices of the first stent and the radius of curvature of the distal apices of the second stent is from about 4 mm to about 9 mm.
17. The stent graft of claim 16, wherein a ratio of the radius of curvature of the proximal apices of the first stent to the radius of curvature of the distal apices of the first stent is between about 2.6:1 to about 18:1.
18. The stent graft of claim 17, wherein a ratio of the radius of curvature of the distal apices of the second stent to the radius of curvature of the proximal apices of the second stent is between about 2.6:1 to about 18:1.
19. The stent graft of claim 16, wherein a ratio of the radius of curvature of the distal apices of the second stent to the radius of curvature of the proximal apices of the second stent is between about 2.6:1 to about 18:1.
20. The stent graft of claim 16, wherein the area of unstented graft material between the rounded inner radius of a proximal apex of the first stent and the rounded inner radius of a distal apex of the second stent opposite the rounded inner radius of the proximal apex comprises and aperture.
21. The stent graft of claim 20, further comprising a second area of unstented graft material between a rounded inner radius of a second proximal apex of the first stent and a rounded inner radius of a second distal apex of the second stent opposite the rounded inner radius of the second proximal apex, wherein the second area of unstented graft material between the rounded inner radius of the second proximal apex of the first stent and the rounded inner radius of the second distal apex of the second stent opposite the rounded inner radius of the second proximal apex comprises an aperture in the second area of unstented graft material.
22. The stent graft of claim 16, wherein the second end of the tube of graft material is bifurcated.
23. The stent graft of claim 16, wherein the plurality of stents includes at least one stent having proximal and distal apices each having a radius of curvature, wherein the radius of curvature of each of the proximal and distal apices is the same.
24. The stent graft of claim 23, wherein the at least one stent is disposed distally of the first and second stents.
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Type: Grant
Filed: Jun 2, 2014
Date of Patent: May 24, 2016
Patent Publication Number: 20140277370
Assignee: Cook Medical Technologies LLC (Bloomington, IN)
Inventors: David Brocker (Carmel, IN), William K. Dierking (Louisville, KY), Alan R. Leewood (Lafayette, IN), Timothy A. M. Chuter (San Francisco, CA), Blayne A. Roeder (Bloomington, IN), Steven J. Charlebois (West Lafayette, IN), Richard A. Swift (South Bend, IN), Sharath Gopalakrishnamurthy (Bangalore), Matthew Huser (West Lafayette, IN), Jarin Kratzberg (Lafayette, IN), Erik E. Rasmussen (Slagelse), Bent Oehlenschlaeger (Lille Skensved), Kim Møgelvang Jensen (Frederiksberg)
Primary Examiner: Andrew Iwamaye
Assistant Examiner: Leslie Lopez
Application Number: 14/293,286
International Classification: A61F 2/86 (20130101); A61F 2/915 (20130101); A61F 2/856 (20130101); A61F 2/07 (20130101); A61F 2/89 (20130101); A61F 2/06 (20130101); A61F 2/848 (20130101);